G97.4 vs T85
G97.4 (Accidental puncture and laceration of a nervous system organ or structure during a procedure) compared with T85 (Complications of other internal prosthetic devices, implants and grafts), from the official CMS tabular data. Both may be reported when both conditions are documented (Excludes2).
Can these codes be reported together?
Yes, when both are documented. T85 carries an Excludes2 note covering G97.4: “intraoperative and postprocedural complications of specified body systems (D78.-, E36.-, E89.-, G97.3-, G97.4, H59.3-, H59.-, H95.2-, H95.3, I97.4-, I97.5, J95.6-, J95.7, K91.6-, L76.-, M96.-, N99.-)”
Excludes2 marks distinct conditions — both may be reported when both are documented.
Side by side
| G97.4Accidental puncture and laceration of a nervous system organ or structure during a procedure | T85Complications of other internal prosthetic devices, implants and grafts | |
|---|---|---|
| Billing status | Non-billable header | Non-billable header Report instead: T85.01XA, T85.01XD, T85.01XS, T85.02XA, T85.02XD |
| Classification | G00-G99 — Diseases of the Nervous System (G00-G99) | S00-T88 — Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88) |
| Definition | Accidental puncture and laceration of a nervous system organ or structure during a procedure is a non-billable ICD-10-CM category code (G97.4). | Complications of other internal prosthetic devices, implants and grafts is a non-billable ICD-10-CM category code (T85). |
| 7th character | — | The appropriate 7th character is to be added to each code from category T85 |
| Use additional code | — | code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5) code(s) to identify the specified condition resulting from the complication code to identify devices involved and details of circumstances (Y62-Y82) |
Derived from the official CMS ICD-10-CM tabular data (FY2026). Not billing advice; verify sequencing rules for the encounter. All data sources